1942934120 NPI number — JESSIE ELIZABETH STEFANESCU CRNP

Table of content: JESSIE ELIZABETH STEFANESCU CRNP (NPI 1942934120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942934120 NPI number — JESSIE ELIZABETH STEFANESCU CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEFANESCU
Provider First Name:
JESSIE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIFE
Provider Other First Name:
JESSIE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942934120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 E CLAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17602-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-314-2500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
562 W 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITITZ
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17543-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-626-2167
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  SP025905 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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